Patient Financial Assistance Program

COMPSPEC's Patient Financial Assistance Program is designed to assist your uninsured patient in obtaining financial coverage for healthcare services. COMPSPEC's Eligibility Specialists screen each case and provide hands-on assistance to the patient in securing eligibility for Medi-Cal, Victims of Crime Program, and/or other applicable thirdparty coverage(s).  Patients who may qualify for such programs are helped along each step of the eligibility process from initial application to final disposition at no charge to the patient.

•       SELF-PAY ACCOUNTS

COMPSPEC proposes to screen every inpatient self pay account to identify potential third party source(s) of payment (i.e. Medi-Cal, Victims of Crime Program, third party liability, and Workers' Compensation, etc.) and to pursue positive resolution by proper processing and follow-up.

This program is implemented by on-site staff assigned on either a permanent or as needed basis.  The means of implementation is dependent upon CLIENT volumes and logistical considerations.

At the request of the CLIENT, COMPSPEC's staff will conduct a monthly analysis to identify accounts for patients potentially eligible for Medi-Cal, Victims of Crime Program, third party liability, Workers' Compensation, insurance, and/or other potential coverage(s).

•      PENDING MEDI-CAL ACCOUNTS

COMPSPEC proposes to follow up on all Medi-Cal cases where an application has been started and the patient still needs assistance in completing the application.  COMPSPEC will utilize its expertise to obtain resolution to the application or secure the Proof of Eligibility.

•      DENIED APPLICATION / LEGAL ACCOUNTS 

COMPSPEC proposes to follow up on all accounts denied for eligibility by assisting the patient in the Administrative Hearings processes or other appropriate legal actions. COMPSPEC will assist or represent the applicant in securing positive resolution (i.e. Proof of Eligibility) for each case.

•      DENIED TREATMENT AUTHORIZATION REQUEST

COMPSPEC proposes to appeal selected denied Treatment Authorization Requests (TAR's), in order to secure positive resolution. COMPSPEC employs the assistance of Registered Nurses who have extensive experience in utilization review, TAR review and appeals processes.  These individuals are well known to the County Field Offices and have proven very successful in obtaining TAR approvals.

•     CASE MANAGEMENT STEPS

• Locate the patient
  

• Explain relationships among the health services provider, COMPSPEC, and the patient
  

• Screen the patient for possible third party payment source(s) (i.e. Medi-Cal, Victims of Crime, Workers' Compensation, and other third party liability, etc.) to initiate the application process
  

• Assist the patient in completing appropriate applications and obtaining all necessary supplemental documentation and provide representation in the appeal process
  

• Follow-up with the Department of Public Social Services, (DPSS), or other appropriate administrative body, through final disposition of each case, including representation in the Fair Hearing Process as indicated for denied applications
  

• When Proof of Eligibility is obtained for Medi-Cal eligibility, COMPSPEC will additionally,
  
  

  • Work with the health service provider to obtain Treatment Authorization Requests (TAR's), including appeals processing as needed AND

  • Provide all billing and follow-up on each account

• When other eligibility is obtained, (i.e. Workers' Compensation, Industrial Accident, California Children's Services, Victims of Crime, other third party liability, etc.), COMPSPEC will submit eligibility determination documents and provide billing and follow up procedures

• In the event of third party liability cases,

•     ADDITIONAL SERVICES AND PROCEDURES

• WORKSHOPS & CLIENT STAFF TRAINING  - COMPSPEC will offer the CLIENT ten (10) free hours of workshops per year on Medi-Cal, Victims of Crime, and other third party reimbursement programs to enhance the CLIENT's staff knowledge.
  

• REPORTS AND CASE CONFERENCES  - COMPSPEC will provide regular status reports to keep the CLIENT abreast of all activities and the status of each account throughout the recovery process.  On particularly interesting or difficult cases, COMPSPEC may conduct case conferences with the CLIENT's staff as part of its commitment to improving the CLIENT's staff knowledge in the area of third party reimbursement and government programs.
  

• BILINGUAL STAFF - To facilitate communications as needed with patients, COMPSPEC will provide bilingual case workers and letters as needed.